Provider Demographics
NPI:1568184778
Name:ANISIA'S HEALTHY LIVING
Entity Type:Organization
Organization Name:ANISIA'S HEALTHY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-947-1549
Mailing Address - Street 1:1904 MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2544
Mailing Address - Country:US
Mailing Address - Phone:916-947-1549
Mailing Address - Fax:
Practice Address - Street 1:1904 MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2544
Practice Address - Country:US
Practice Address - Phone:916-947-1549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility